Modern healthcare requires the provision of services to patients by many health-care workers at a multiplicity of locations and involves a corresponding multiplicity of organizations (e.g. companies, payers, institutions, physician practices, clinics, hospitals, pharmacies etc.). Healthcare operations are structured into specialized departments such as nursing, laboratory, radiology, pharmacy, surgery, emergency, administrative and other departments which are variously located at one or more sites and may be associated with different organizations. The management of organization information involves accumulating, processing and maintaining large quantities of information. This information is employed in determining organizational relationships, affiliations and characteristics used in creating a representative organizational model supporting provision of clinical care, patient tracking, billing and administration and other purposes. Consequently, there is a need for a computerized system capable of defining and maintaining organization information for a health care enterprise and for supporting healthcare system operation by defining, processing and filtering organization information for presentation to users and other system software applications.
Available organization information management systems have limited capabilities and numerous deficiencies. Specifically, available systems are typically restricted in organization structure models that are supported. Available systems also have a limited capability to identify and define and model specific organization characteristics and structures. One known system provides a fixed hierarchical organization structure of seven levels including: a healthcare enterprise, a billing organization, a billing office, clinics and departments, a specialty, a reserved level and providers. These levels are constrained to be identified when the associated model structure is created. Further, the defined hierarchical organization model is limited in its ability to support billing administration for entities at the different levels (e.g. for different organization healthcare reimbursement plan groups at different levels of the structure).
Other limitations of the known system include an inability to accommodate types of organizational relationships. These include, for example, relationships among organizations external to a billing function and other loose affiliations within a health system (encompassing a service provider not affiliated with the health system, but required for use by the patient's payer, for example). Further, limitations include lack of search and reporting capability and inability to portray an organizational structure in a user selectable hierarchical, flat or other format. Other available organization information system deficiencies include an inflexible interface for updating and maintaining an organization profile that typically requires off-line system re-programming. In consequence it is desirable to provide an organization information system that is robust, flexible, comprehensive and user-friendly. A system according to invention principles addresses the identified deficiencies and derivative problems.